| Objective:To compare the clinical effects of circular external fixator with unilateral external fixator applied in treatment of tibial bone defect, and to analyze their advantages and disadvantages, indications and contraindications, complications. Our aim is to provide references for choices of external fixators in treatment of tibial bone defect.Methods:A retrospective analysis of 55 cases with tibial bone defect treated with either circular external fixator or unilateral external fixator at The First Affiliated Hospital of Guangxi Medical University from June 2010 to September 2015 was conducted. All patients were obtained regular follow up There were 27 patients with a mean age of 35.3±2.4 years (range:30-58 years), including 20 male and 7 female in circular external fixator group and 28 patients with a mean age of 37.3±2.6 years (range:35-56 years), including 18 male,10 female in unilateral external fixator group. The patients in two groups with tibial bone defect derived from osteomyelitis after operation for original tibial fracture were indicative for surgery of osteotomy and bone transport. All operations in two groups were performed by experienced senior surgeons and the type of external fixator was determined by the surgeon according to the conditions of bone defect and patient’s finances. During the operation both bone ends of the defect in the patient were cleaned, circular or unilateral external fixator was placed and osteotomy was performed. Bone transport was initiated a week after operation. The patients in two groups had a period of follow up from 6 months to 18 months. The patients in circular external fixator group got an average 10 months of follow-up, and unilateral external fixator group, an average 9.5 months of follow-up. The parameters of bone defect length, operative time, blood loss, clinical bone healing rate, and complications between two groups were compared. Advantages and disadvantages of the two fixators were analyzed and indications for application were suggested.Results:The length of bone defect in circular external fixator group was 9.7 ±3.1cm (range:4.1-13.9 cm); in unilateral external fixator group was 9.6±2.7 cm (range:3.7-14.4cm). There was no significant difference (P> 0.05) between the parameters of bone defect length, bone defect healing time, radiographic healing index, external fixation index, clinical healing rate in two groups. Blood loss in unilateral external fixator group was 100.71±15.85ml, in circular external fixator group was 178.15±39.23ml. Operation time in unilateral external fixator group was 108.25±15.12min, in circular external fixator group was 272.37±30.25min. Postoperative excellent and good rate in unilateral external fixator was 60.7%, with excellent in 10 cases, good in 7 cases, medium 6 cases, and poor in 5 cases; The excellent and good rate in circular external fixator was 85.2% with excellent in 17 cases, good in 6 cases, medium 1 case, and poor 4 cases. There were statistically significant differences (P<0.05) in operative time, blood loss, and postoperative excellent and good rate between two groups. There was foot drop in 4 cases, pin tract infection in 4 cases, pain during bone transport in 5 cases, nonunion that healed after autologous bone graft at docking site in 2 cases, no callus formation at osteotomy area after bone transport in 1 case, and early mineralization at osteotomy area in 1 case in circular external fixator group. In unilateral external fixator group. There was foot drop in 3 cases, pin tract infection in 5 cases, pain during bone transport in 4 cases, bone nonunion that healed after autologous bone graft in 3 cases, misalighment (angulation, rotation, lateral displacement) after bone transport that were corrected via adjustment operation in 8 cases. Clinical bone healing rate in circular external fixator group was 85.2%, with mean healing time of 8.9 ±1.5 months (range:5-10 months); Clinical bone healing rate in unilateral external fixator group was 82.1%, with average healing time of 9.3±1.6 months (range:4-10.5 months).Conclusion:Both circular external fixator and unilateral external fixator are effective in the treatment of tibial bone defect but each has its advantage and disadvantage. Bone transport with circular external fixator has the advantage of lower possibility of docking offset compared to unilateral external fixator, but the operation is relatively more complex with higher technique requirement. Bone transport with unilateral external fixator has the advantages of shorter operation time, less blood loss, and more simple operation, but relatively higher possibility of docking offset. |
PDF Full Text Request